The Challenge
An employee benefits services firm helps self-insured employer groups control costs, working alongside third-party administrators, brokers, and pharmacy benefit managers. One of its core services is drug cost containment: finding lower-cost paths for high-cost specialty medications without disrupting care.
Each case involves clinical review, research across multiple vendor solutions, approvals, monthly refill and eligibility tracking, and fees billed to the client. All of it lived in spreadsheets and free-text notes, which made it hard to see what was due, what had been saved, and what was ready to bill.
The firm needed a platform that could:
- Track every case from clinical review through ongoing refills.
- Keep relationships between employers, administrators, brokers, and pharmacy benefit managers accurate over time.
- Automate the reminders and checks that keep cases on schedule.
- Protect sensitive health information to the standard the work requires.
The Approach
BRIO began with process analysis and discovery to map how each business line actually works, then designed a Salesforce data model around those processes. Security and compliance came first: the org was set up with single sign-on, multi-factor authentication, and protections for sensitive fields before any health information was stored. Drug cost containment went live first, with the firm’s other business lines following in later releases.
The Solution
A Data Model Built Around the Work: Custom objects track engagements, medical reviews, vendor solutions, prescriptions, drugs, eligibility, and fees. Account types distinguish employers, administrators, pharmacy benefit managers, vendors, brokers, providers, and carriers, and relationships are tracked over time with one active at a time.
Automation That Keeps Cases Moving: Refill reminders arrive two weeks ahead, new-prescription tasks are created when refills run out, and next fill dates calculate automatically. Monthly eligibility checks and billing-readiness alerts keep the team ahead of what is due.
Fees and Billing Without the Scramble: Fees can be set at the client, engagement, or prescription level, with more specific settings taking priority. Items are marked ready to bill and exported monthly to the firm’s accounting system.
Reporting From Day One: A go-live dashboard and a set of reports cover savings tracking, refills due, and data quality checks.
Security to Match the Data: Single sign-on, required multi-factor authentication, encryption, and field-level security protect sensitive information, with role-based access and a dedicated app for each business line.
Connected to Everyday Tools: An email add-in brings Salesforce into the inbox, and document links connect records to the firm’s existing file storage.
Technical foundation
- Salesforce with a custom data model for drug cost containment
- Single sign-on with multi-factor authentication
- Encryption and field-level security for sensitive fields
- Flow automation for refills, eligibility, and billing readiness
- Monthly export to the firm’s accounting platform
- Dashboards and reports for savings and operations
The Impact
The first business line moved from spreadsheets to a purpose-built platform:
- Drug cost containment live on Salesforce, with the team entering work there from launch.
- Refills, eligibility, and billing tracked automatically instead of by hand.
- One view of relationships across employers, administrators, brokers, and pharmacy benefit managers.
- A secure foundation for the firm’s additional business lines.
When the work is specialized and the data is sensitive, the right platform starts with the process and the protections, then makes the daily work easier from there.
